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According to the American College of Sports and Medicine, an average American adult takes more than 5000 steps per day. While this sounds a lot, you will be unhappy to know that we walk less than the average adults of other countries do. (1) And yet, we are a nation where foot problems are very common. A study conducted by the American Podiatric Medical Association concluded that approximately 77% American adults have experienced foot pain. (2) There are a lot of common foot problems that each one of us could experience in our lifetime which includes bunions, athletes’ foot, blisters, heel spurs, cons, flat foot, and plantar fasciitis. (3) In this article, we will be discussing Plantar Fasciitis.
The American Academy of Orthopaedic Surgeons claims that Plantar Fasciitis is the most common cause of heel pain. Around 2 million patients are treated for this condition every year. (4) Stabbing pain in the heel is one of the most common plantar fasciitis symptoms. The pain is worse in the morning when you take your first few steps. It gradually decreases during the day but the plantar fasciitis pain can start again after a long period of rest. Thankfully, in most cases, conventional plantar fasciitis treatment is sufficient for treating the pain. Conventional treatment includes rest, ice-pack application, anti-inflammatory medicines (only if required), stretching and other plantar fasciitis exercises, and wearing orthotics or supportive insoles. In some cases, patients may not get much relief from the conventional plantar fasciitis treatment and may require corticosteroid injections, night splint, and even plantar fasciitis surgery. (5)
Plantar Fasciitis is a painful condition caused by the inflammation of plantar fascia, a band of tissue that connects the heel with the toes. For years, doctors had thought the inflammation to be the cause of the plantar fasciitis pain. However, some recent studies have indicated that the inflammation is not the cause but a sign of this foot problem. (6) (7) The plantar fasciitis causes could be many including but not limited to degeneration of the plantar fascia tissue, aging, excessive stress on the leg muscles due to strenuous activities, obesity, bad footwear, and much more. Identifying the root cause is important for determining the most effective plantar fasciitis cure.
As of now, there are hardly any studies conducted on the effect of plantar fasciitis on lifestyle. However, heel pain can make walking and running difficult. Athletes, runners, and joggers will feel the pain during the start and at the end of the activity but the pain will be reduced substantially during the activity. On-time and correct plantar fasciitis treatment can prevent the problem from becoming chronic. Before finding out the best treatment options, let’s first find out what is plantar fasciitis and why you are suffering from plantar fasciitis pain.
The sole of our foot is referred as plantar area and the term fascia is used for referring a band of connective tissues that lie beneath our skin and they attach, surround, stabilize, and separate the muscles and the organs. As the name suggests, Plantar Fascia is the band of connective tissues that are present at the plantar area of our foot. It connects the heels with the toe bones and acts as a bowstring. Plantar fascia supports the arch of our foot and helps bear the strain of the daily activity.
Excessive strain can damage the tissues of the plantar fascia, which may lead to inflammation. The stain could be due to high-intensity activities such as running, jumping, and even walking. Improper footwear and some diseases are also responsible for its damage. When the tissues are damaged, you will feel plantar fasciitis pain. Thankfully, the damage is not irreversible. Adequate rest, plantar fasciitis stretches, and addressing the underlying cause can help you get rid of this painful condition within a few weeks. Wearing plantar fasciitis shoes is highly recommended during and after the treatment to avoid the condition from exaggerating.
Please note that in some cases, you may suffer from plantar heel pain even if there is no inflammation in the plantar tissues.
Sharp, stabbing heel pain that typically occurs in the morning with the first few steps is one of the most notable plantar fasciitis symptoms. The pain will be severe when you take the first few steps and it will gradually subside during the day. However, you can experience pain after a long period of rest. If you are an athlete, you will experience severe pain at the beginning and at the end of the activity but you will be almost fine during the activity.
Other plantar fasciitis symptoms include:
As mentioned above, damaged plantar fascia tissue is the main cause of plantar fasciitis. The damage could be due to a number of reasons such as:
Sudden increase in the intensity of your exercise
If you have taken up a new form of exercise or have suddenly increased the intensity of your activity, you are more prone to suffer from heel pain, especially if you have a sedentary lifestyle. But, this doesn’t mean you must not exercise too much. You can take the intensity of your workout/activity as high as it is possible for you but not suddenly. Increase the intensity slightly every day and let your body adjust to it gradually. A sudden change can put a lot of pressure on your heels, thereby affecting the arches and the plantar fascia. If you believe this is the reason behind your heel pain, discontinue the activity for a few weeks and seek plantar fasciitis treatment. Let the tissues heal completely before you start again.
Studies have concluded that there is a consistent clinical association between obesity and plantar fasciitis. (8) Excess weight adds tremendous pressure to your knees, ankle, foot, their muscles, and the whole skeletal system. It is obvious that your plantar muscles will also have to bear a lot of weight during your daily activity. This excessive strain can damage the muscles leading to inflammation and pain. If you are obese, losing some weight can provide you significant plantar fasciitis relief.
Plantar fasciitis is a common sports injury. (9) High-intensity activities such as running put a lot of pressure on the calf muscles, knees, hips, foot arches, and the plantar fascia muscles. Since the plantar fascia is responsible for stabilizing the inner forefoot during the push-off, the pressure on it becomes almost 7 times during running. The pressure is even more for hill runners, barefoot runners, and long-distance runners. Thankfully, you can avoid this problem by wearing the best shoes for plantar fasciitis. If you have already started experiencing heel pain, consult your physician to find out about plantar fasciitis stretches and exercises that will help you overcome the pain.
Various studies have concluded that people who overpronate are more likely to suffer from plantar muscle damage. (10) More than 80% people with plantar heel pain suffer from overpronation. (11) Due to their abnormal gait, the plantar fascia gets stretched away from the heel bone causing micro tears. Wearing supportive plantar fasciitis inserts or shoes can help you deal with this condition. Such shoes will provide support to your fallen arches and correct the overpronation.
High arches or fallen arches
People with abnormal arch height have high chances of suffering from plantar heel pain. Whether you have fallen arch (12) or high arch (13), the arch and the plantar fascia muscle of your feet will be forced to bear the excessive stress of the daily activities. Further, if you are an athlete, the stress will be even more, thereby increasing the chances of plantar fascia damage and inflammation. Please note that having an unusual arch height doesn’t necessarily mean that you will suffer from plantar fasciitis. Supportive plantar fasciitis shoes will help you take pressure off the heels and prevent plantar heel pain for a long time. Further, flat feet and plantar fasciitis exercises can help you get rid of pain quickly.
Standing for long hours
If you are in a profession that requires you to be on your feet for long hours, you are more likely to suffer from plantar fasciitis. (14) Further, work-related weight bearing and obesity can increase the chances of damage to the plantar fascia. Healthcare professionals, teachers, factory workers, police officers, people in hospitality industry etc. are some of the most affected people. You must not, therefore, stand on hard surface for long hours without wearing plantar fasciitis insoles or shoes.
Tight or weak leg and foot muscles
Tightness or weakness of calf muscles, foot muscles, hip flexors, Achilles tendon, and other intrinsic foot muscles can cause plantar fasciitis. (15) Stiffness in leg muscles puts extra strain on the plantar fascia, especially during the push-off. Stiffness also affects your motion, thereby affecting your ankle, knees, and hip. Weak or stiff foot muscles will change your gait pattern, which can further increase the strain.
Although foot problems can happen to anyone in any age group, elderly people are more likely to suffer. With age, the muscles, ligaments, and tissues start degenerating. The plantar fascia, like all other muscles, starts losing its strength and elasticity. It becomes weak and more prone to damage. Plantar fasciitis shoes and inserts are highly recommended for people above 40 years and have an active lifestyle, even if they are not suffering from plantar fasciitis pain.
Ladies, if you are in love with high heels be aware that wearing them too often and for long duration can damage the plantar fascia tissues making you prone to plantar fasciitis. (16) (17) High heels distribute the body weight unevenly. They also force the arch to stay in an unnatural position. Repetitive use can weaken the arch and the plantar fascia muscle. Other than high heels, ill-fitted, worn out footwear can also damage the foot muscles. So, choose your footwear carefully.
There are a lot of misconceptions and misunderstandings regarding plantar fasciitis. Before we brief you about conventional and non-conventional plantar fasciitis treatment options, let’s first understand this foot condition completely and correctly.
Myth 1: If you are flatfooted, you will definitely suffer from plantar fasciitis
This is not completely true. Persons with fallen arches are more prone to heel pain but, if you take appropriate care, you can stay away from this foot condition for decades. When the arch collapses, the sole of your foot touches the ground completely, thereby adding pressure on the plantar fascia. By wearing some of the best shoes for plantar fasciitis or for flat foot, you will be able to support the fallen arch and release the pressure off the plantar muscles. Flat feet exercises can further help you improve your arch height. If you are a flatfooted person, here are some exercises that you must do regularly. Need help choosing the right footwear? Here is a list of some of the best insoles for flat feet. Refer this blog to find out the best shoes for flatfooted persons relevant for their occupation and lifestyle.
Myth 2: If you overpronate you will definitely suffer from plantar fasciitis
As mentioned above, more than 80% plantar heel pain patients suffer from overpronation. But, that doesn’t mean overpronation is one of the leading cause of plantar fasciitis. Neither plantar fasciitis causes overpronation nor does overpronation cause plantar fasciitis. These foot conditions are just related to each other because of the way they affect the foot. When you overpronate, your plantar fascia muscle stretches in an unusual way. If you don’t take care of the pronation issue on time, the plantar muscle may get micro tears, which may lead to plantar fasciitis. Even people who do not overpronate are at equal risk of suffering from plantar fasciitis pain.
Myth 3: Plantar fasciitis and heel spurs are the same / heel spurs causes plantar fasciitis
They are not same, although heel pain is the main symptom of both these foot conditions. A heel spur, also known as calcaneal spur, is a bony outgrowth at the bottom of the heel above the attachment of plantar fascia. This outgrowth is due to calcium deposit. In most cases, heel spurs are not associated with pain, whereas plantar fasciitis is always associated with heel pain. Heel spurs are harmless but if you are suffering from pain, you should wear orthotics. If the pain is severe, you may have to get it removed through surgery, but, such cases are rare. The best way to identify if you have plantar fasciitis and not heel spur is to walk on your toes. If it doesn’t pain when you walk on your toes, you are suffering from heel spur pain and not plantar fasciitis pain.
Plantar fasciitis home remedies are highly effective for getting relief from pain and inflammation. The objective of plantar fasciitis treatment is to let the damaged muscles heel completely. However, just healing is not enough. You need to find out the exact cause of the problem and address it or else the pain will make a comeback soon. Evaluating your lifestyle and physical health will help you identify the correct reason. However, you must consult a general physician or a podiatrist (i.e. a person specializing in foot problems) to find out how you can keep plantar fasciitis away forever.
In most cases, conventional home remedies such as rest, ice pack application, plantar fasciitis exercises, stretches, massage, and plantar fasciitis shoes are enough for healing the strained muscles. If you are obese, you must try to lose some weight. However, if the pain is severe, your doctor may recommend you non-steroidal anti-inflammatory drugs and plantar fasciitis injection, which mainly contains Cortisone. Surgery is required in very few cases where the pain has become chronic and the conventional plantar fasciitis remedies have failed to provide any relief.
Here is how to treat plantar fasciitis at home:
Ever wondered how to treat plantar fasciitis quickly and effectively? Just do nothing! Yes, that’s all your feet need. Plantar fasciitis pain indicates that your feet are tired and they need some rest. So, take a break from all your high-impact sports such as running and jumping but you may continue the activities that do not strain your feet such as swimming.
While rest is very important, avoiding all your daily activities is almost impossible. You must, however, try to eliminate as much work as possible. The more rest you take, the sooner the muscles will heel. Usually, one to two weeks of rest is enough to get rid of the heel pain, but, you must take appropriate care even after the resting period is over as your muscles will take time to heel. If you are in a profession that requires you to be on your feet for long hours, you must wear plantar fasciitis shoes or insoles. Here are some of the best plantar fasciitis insoles that you may buy. If you are suffering from plantar heel pain, do not walk barefoot. Barefoot walking can further worsen the pain. You must wear supportive shoes and insoles all the time until the pain is gone.
Ice pack application during the resting period can help you get much relief from heel pain. You can either roll a frozen plastic water bottle at the bottom of your foot or buy ice pack slippers. Ice pack slippers are great as you can carry them to work. They are not messy and can stay in place with soft Velcro straps. Please note that icing doesn’t heel the damaged tissues. It simply numbs the pain.
Still worried how long does plantar fasciitis last? Honestly, it can take a few weeks to a few months to get rid of the pain completely. The duration depends on how severe your condition is and how well you address the pain.
Taut foot muscles can aggravate plantar fasciitis. Improving their flexibility and strength is, therefore, very important for getting long-term relief from this foot problem. Various studies have concluded the effectiveness of plantar fasciitis stretches and exercises. (18) (19) (20) Here are some simple and yet highly effective plantar fasciitis exercises that you can do anytime and anywhere.
Achilles tendon and Plantar Fascia stretch
Achilles tendon is a thick band of muscle that connects the calf muscles to the heel bone. The stiffness of Achilles tendon can worsen the plantar fasciitis pain and slow down the healing process of the damaged muscles. To increase its flexibility, roll up a towel or take an elastic band or exercise strap and loop it around the ball of your foot. Keep your knees straight and pull your toes towards your nose. Hold it for 20-30 seconds. Repeat at least 5 times for each leg.
These plantar fasciitis stretches also target the calf muscles. To do this, place your hands on the wall at your shoulder level. Place one leg behind the other. Now gently bend the knee of the front leg as much as you comfortably can. Keep the other knee straight. Hold this position for 20-30 second and repeat for 5 times. Reverse the position of your leg and repeat. This is a great exercise for flatfooted people too.
Once you get used to this stretch, you can deepen the stretch by bending both the knees.
This is another simple and yet highly effective plantar fasciitis stretch. All you need to do is to hold all your toes with your hands and pull them up towards your nose. Hold this position for 20-30 seconds, repeat 5 times, and then stretch the toes in the reverse direction. You can do it 3-5 times a day.
This plantar fasciitis stretch targets both the plantar muscles as well as the Achilles tendon. To do, step on a stair in a way that the heels are off the end of the step. Hold the rail for support. Now, lower your heels keeping the knees straight until you feel a slight tightness in your calf muscles. Hold this position for 20-30 seconds and repeat 5 times twice daily. You can do it with one leg at a time or both legs together.
Trigger Point Therapy (Massage)
Trigger points are the muscles knots formed in the muscles that are either underworked or overworked. These knots are the common cause of many stubborn aches and pains. If not treated, they can cause unexplained spasms and pain in the nearby muscles. Our foot and calf muscles also have a lot of such trigger points that can increase the heel pain plantar fasciitis as well as slow down the healing process of the damaged plantar muscles by reducing the blood supply to this region. Thankfully, treating these trigger points is pretty easy. All you need to do is to massage them. You may either go for self-massage or opt for a professional deep tissue plantar fasciitis massage.
To treat the trigger points for plantar fasciitis, roll your affected foot over a cold and round object. You can roll a frozen water bottle, a soda can, a rolling pin, or just a ball. Using a frozen bottle or a cold can is advisable as they will help you get quick relief from plantar fasciitis symptoms just like the ice pack would do. If not, you can simply use a foam roller. Do this exercise twice daily for 10 minutes with each leg. Combining plantar fasciitis massage therapy with plantar fasciitis stretches will give you better as well as faster benefits. (21)
Resting, stretching, and trigger point massage will help you get rid of plantar heel pain within a few weeks. However, plantar fasciitis treatment must not be limited to just treating the pain. The treatment plan should also include options that will help you address the root cause of the problem and strengthen your plantar and calf muscles so that the heel pain doesn’t retaliate. Strengthening the calf and leg muscles also helps get rid of the pain quickly. (22) (23)
Plantar fasciitis exercises are important for strengthening your plantar muscles as well as for improving their flexibility. By practicing them regularly, you will be able to take stress off your plantar muscles, thereby minimizing the chances of suffering from plantar fasciitis. Here are some strengthening exercises that you may try.
Please note that you must not start these exercises when you are already experiencing severe to moderate plantar heel pain. These exercises should be done as a part of preventive measures and therefore, you must start them when your plantar fasciitis symptoms have healed. Start these exercises slowly and, if you experience any discomfort or pain, stop them immediately and consult your physician.
Low-dye tape is a 1-inch wide zinc oxide tape that you can buy from your nearby chemist or from Amazon and other online stores. This athletic tape is designed to take the load off the plantar fascia muscles so that they can heal faster and better. Watch the below video to find out how the tape needs to be tied around your foot. You must get the plantar fasciitis taping done by a physician or a podiatrist instead of doing it yourself because if you fail to tie it correctly, it won’t be of any help.
Plantar fasciitis taping is very effective for reducing plantar heel pain and enhancing the stability. (25) (26) It can be used for correcting many other foot and heel pains as well as for supporting the foot during the workout. The taping needs to be changed every day or as recommended by the tape manufacturer or your podiatrist. It may cause minor side effects such as rashes, blisters, etc. Please note that plantar fasciitis taping is a short-term plantar fasciitis treatment meant for providing pain relief. It cannot heal the inflammation but it will definitely make the healing process faster.
If you are obese, losing weight should be your top agenda while seeking plantar fasciitis treatment. However, this can be a real challenge, as the heel pain won’t let you opt for cardio, weight training, running, jogging, and other high-intensity workouts. You can, however, go for low-impact exercises such as swimming, water aerobics, spin cycling, rowing, and yoga. These exercises are excellent calorie burner and yet they won’t strain your legs. You must also consult a dietician to help you manage your weight through diet.
Plantar fasciitis requires you to keep your feet relaxed. While rest is really important for healing, there are a lot of products that can help you to continue doing your daily activities without straining your feet. Some of the popular products are plantar fasciitis socks, shoes, inserts, plantar fasciitis braces, night splints, etc. Various studies have proven that these products can not only reduce your plantar heel pain but also assist in quick healing. Here are some of the products that we recommend.
If you have been detected with plantar fasciitis, the first thing your doctor will ask you to do, apart from resting, is to buy a good pair of plantar fasciitis shoes. Well-fitted, supportive shoes can take the load off the heel, thereby helping in quick healing. Therefore, you must not hesitate to buy a good pair of plantar fasciitis shoes. Never wear worn-out shoes or shoes with inappropriate arch and heel support. Such shoes will only aggravate the pain.
Here are some helpful tips for choosing the best shoes for plantar fasciitis:
Good arch support
The right amount of arch support is probably one of the most important factors that you must consider while buying any shoes, including the ones for plantar fasciitis. If you have fallen arches or high arches, look for shoes that are meant to address your foot condition.
Elevated heel counter
The best plantar fasciitis shoes are the ones that have slightly elevated, firm heel counters. An elevated heel counter will take pressure off the heels and the Achilles tendon.
Always buy well-cushioned plantar fasciitis shoes. If the cushioning is not enough, it will not take pressure off the heels and can further aggravate the condition. However, if the cushioning is too much, it won’t be able to support your arches properly, thereby causing more discomfort. Finding a fine balance is important.
As mentioned above, plantar fasciitis is often associated with overpronation. You must, therefore, get your gait checked up by a podiatrist to find out what types of shoes will be right for you. Always buy shoes that are meant to correct your gait pattern. Unless your overpronation is resolved, you will not be able to get rid of plantar fasciitis for a long time.
You obviously can’t buy too many pairs of plantar fasciitis shoes for your work, for casual wear, beach wear, for jogging, etc. Orthotics are, therefore, a great alternative. You can use them in your current shoes and yet, you will get all the benefits that you would get from any good pair of supportive shoes. Numerous studies have proven the benefits of orthotics for reducing plantar fasciitis pain as well as accelerating the healing process. (27) Studies have also proven that foot inserts are effective for both long-term and short-term pain reduction. You can use them as an initial treatment for plantar heel pain as well as a preventive measure. (28) Further, including stretching exercises along with wearing good insoles for plantar fasciitis will produce much better results than only wearing an insert. (29) So, your plantar fasciitis treatment plan must include a variety of remedial measures than just sticking to one of them.
For years there has been a debate on the effectiveness of custom orthotics versus the prefabricated ones. If you are planning to buy a pair of really expensive custom insert assuming that it will help you recover faster, we would like you to know that it won’t make any difference. Studies have concluded that the prefabricated orthotics are as good as the customized ones and that there is no major difference in their pain-relieving capacity. In fact, one of the studies has proven that prefabricated inserts along with stretching exercises can give better results than using customized orthotics only. (29)
Wondering why physicians recommend custom inserts if they do not provide anything better than the prefabricated ones? Well, they are good for people who have an unusual arch height or are unable to find inserts that fit them well and support their feet adequately. If you can’t find an insert that fits you well, you may also opt for the customized ones.
Plantar fasciitis night splint is a brace like device that helps maintain a 90-degree angle between the foot and the ankle at night when you are sleeping. This helps keep the plantar fascia muscles and the calf muscles stretched throughout the night, thereby accelerating its healing process. When we sleep, our toes point downwards. This keeps the plantar fascia muscle contracted throughout the night. The contraction further strains it and causes severe heel pain in the morning. Various studies have proven that plantar fasciitis splints are effective for both short-term as well as long-term plantar heel pain. (30) Plantar fasciitis braces provide a constant and consistent strain to the plantar muscles. This strain not only helps maintain its functional length but also reduces the stress on the plantar, calf, and other leg muscles. When used in combination with stretching exercises, the plantar fasciitis braces will produce better results. (31)
Plantar fasciitis night splints are recommended for people who have been suffering from heel pain for more than three months and haven’t benefitted much from the conventional remedies. (32) These braces could take up to 12 weeks to give you some results but unfortunately, most patients fail to tolerate them for more than 2 weeks. The splints are uncomfortable and they may adversely affect the sleeping habits, thereby affecting your productivity and overall health. (33) However, if you manage to use them, you will most probably get benefitted.
There are three types of plantar fasciitis splints; the posterior splints, the anterior splints, and the socks. The posterior splint, also known as boot splint has an open design. The spine of the brace is on the back of the leg and the calf muscles. It is larger than the anterior splint, which covers the leg from the front side, leaving the heel and arch free to breathe. The sock splints are just like socks. You just need to slip them on and they will hold your foot in a stretched position. You can wear any of them as per your convenience but make sure you wear it consistently for at least a few months.
Conservative planters fasciitis treatments are effective in the majority of the cases. However, in a very few cases, they may not be able to provide you much relief. If your heel pain lasts for more than one year, your physician will suggest you to go for these options:
It is a non-invasive treatment option in which high-energy sound waves i.e. shock waves are applied to the heels. Various studies have proved that extracorporeal shockwave therapy is effective for treating plantar heel pain. (34) Europe has been using this therapy for a very long time but it was officially introduced in the United States in 2000. The success rate of shockwave therapy is more than 80% which is as good as the success rate of surgery.
These injections are made of steroids, numbing medicines, or a combination of both. (35) They are injected at the most painful site. Corticosteroids create a numbing effect that will last for a few weeks to a few months. Most doctors will suggest you to start doing plantar fasciitis exercises as soon as you get some relief. Although plantar fasciitis injections are effective (36), they provide only short-term benefit. Further, there are a few risks associated with this therapy including thinning of fat pad, bleaching of skin, and even tearing of plantar fascia. (35)
If you are suffering from chronic plantar heel pain that refuses to go away conventionally, your physician may suggest you a surgery to remove or release the damaged part of the plantar fascia. Surgery is effective (37) but it is usually not recommended unless it is the last resort.
We hope this article provides you sufficient information on plantar fasciitis and how you can deal with it. Refer our other blogs to know more about plantar fasciitis and other foot problems.
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Last updated on March 29th, 2018